Hip Replacement Patients Benefit From Apixaban

The clot-inhibiting drug apixaban (trade name: Eliquis®) was approved in May 2011 for the prevention of thrombosis (blood clots) after operations to replace a hip or knee joint. In an early benefit assessment pursuant to the “Act on the Reform of the Market for Medicinal Products” (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) examined the added benefit of apixaban.

IQWiG found proof of minor added benefit for adult patients who had undergone hip replacement: symptomatic clots in the deep veins of the leg occurred less frequently with apixaban treatment than with the comparator therapy.

Symptomatic clots in the deep leg veins also occurred less frequently with apixaban treatment in adults after knee replacement. However participants in the studies suffered clots in the lungs (pulmonary embolisms) more often under treatment with apixaban than the comparator group. From weighing up the benefits and harms (risk of side effects) on the basis of the data presented in the manufacturer’s dossier, IQWiG identified no proof of added benefit of apixaban over the appropriate comparator therapy in knee replacement operations.


Enoxaparin as comparator therapy

After the insertion of an artificial hip or knee, there is an increased risk of blood clots (thrombi) that are swept away in the bloodstream and can block a blood vessel in another part of the body. Clots that cause symptoms (symptomatic thromboembolism) may, for instance, occur in the lungs and deep veins of the legs.

Apixaban is approved for the prevention of venous thromboembolism (VTE) in adults following hip or knee replacement surgery. The Federal Joint Committee (G-BA) specified low molecular weight heparins (clot inhibitors), which are approved for the prevention of deep vein thrombosis, as the appropriate comparator therapy. The comparison between apixaban and the drug enoxaparin chosen by the manufacturer in its dossier corresponds to this definition.


Added benefit offset by lesser benefit in knee replacement surgery

Deaths were generally rare in both the relevant studies and mortality with apixaban treatment in hip or knee replacement operations did not differ from that with enoxaparin. With both types of surgery, the incidence of bleeding or other side effects and study withdrawals was also no greater under apixaban than under the comparator therapy. Neither of the relevant studies examined the quality of life.

Both studies showed that apixaban was more effective in preventing symptomatic deep vein thrombosis than the comparator therapy: about one in 1000 patients who took apixaban developed a symptomatic deep vein thrombosis; the figure for patients who injected enoxaparin was about 4 in 1000. A minor added benefit of apixaban is proven in this case.

In hip replacement surgery, there was no difference between the treatment groups in respect of pulmonary embolisms. However after knee replacement, these occurred more frequently under apixaban than under enoxaparin: About 5 in 1000 patients who took apixaban had a pulmonary embolism, compared to about one in 1000 under enoxaparin. This leads to an indication of a lesser benefit of apixaban compared to the comparator therapy. The extent of this lesser benefit was classified as “considerable”. From weighing up the benefits and harms on the basis of the data presented in the manufacturer’s dossier, IQWiG found no proof of added benefit of apixaban over the appropriate comparator therapy in knee replacement surgery.


G-BA decides on the extent of added benefit

The dossier assessment is part of the overall procedure for early benefit assessment conducted by the G-BA. After publication of the manufacturer’s dossier and its assessment by IQWiG, the G-BA initiates a formal commenting procedure which provides further information and can result in a change to the benefit assessment. The G-BA then decides on the extent of the added benefit, thus completing the early benefit assessment.

Infections In Rheumatoid Arthritis Patients: Mayo Clinic Study Finds Way To Pinpoint Risk

Rheumatoid arthritis alone is painful and disabling, but it also puts patients at higher risk of death. The greater susceptibility to infections that accompanies the autoimmune disorder is one reason. Assessing the danger of infection a particular patient faces so it can be addressed can prove challenging for physicians. A Mayo Clinic study finds that a risk score can be developed to predict a patient’s chances of having serious infections. The score uses information about how rheumatoid arthritis is affecting a patient, plus factors including age, corticosteroid use and the presence of other illnesses.

The findings are published online in the American College of Rheumatology journal Arthritis Rheumatism.

Using the National Institutes of Health-funded Rochester Epidemiology Project, researchers studied medical records of 584 rheumatoid arthritis patients diagnosed between 1955 and 1994 and followed up on until January 2000. Of those, 252, or nearly half, had more than one serious infection requiring hospitalization and/or intravenous antibiotic; those 252 collectively racked up 646 infections.

The Mayo team developed an infection risk score based on those and other rheumatoid arthritis patients they studied. Factors in the calculation include age; previous serious infections; corticosteroid use; a low white blood cell count; elevated results in a blood test used to detect signs of inflammation, called an erythrocyte sedimentation rate; signs of rheumatoid arthritis outside joints; and the presence of other serious conditions such as heart disease, heart failure, diabetes, lung disease, vascular disease and alcoholism. They confirmed the usefulness of the risk score in a second group of patients with rheumatoid arthritis from the same population.

“Using a risk score in this way can alert physicians that their patient is at high risk for infection and needs more frequent follow-ups, measures for infection prevention and possible changes in treatments,” says senior author Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic.

“Rheumatoid arthritis patients are at higher risk of infection, and that risk is clearly not just because of the arthritis drugs.”

More research is needed to determine the level of infection risk at which patients get the most benefit from medications to prevent infection and how infection risk might affect use of a category of rheumatoid arthritis drugs called disease-modifying antirheumatic drugs, or DMARDs, such as biologics, the study says.

Introducing Decision Aids May Lower Surgery For Arthritis

Main Category: Arthritis / Rheumatology
Article Date: 06 Sep 2012 – 0:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:not yet rated

Healthcare Prof:not yet rated

After Group Health Cooperative introduced video-based “decision aids” for people with knee and hip arthritis, rates of knee and hip replacement surgeries dropped sharply: by 38 and 26 percent, respectively, over six months. The cost of caring for those patients also declined: by 12 percent to 21 percent, according to an article in the September Health Affairs.

“Decision aids are balanced sources of information that clearly present the evidence-based pros and cons of treatment options for a health condition,” explained study leader David E. Arterburn, MD, MPH, a general internist and associate investigator at Group Health Research Institute.

This observational study of 9,515 Group Health patients compared six-month outcomes during two periods: before and after decision aids for knee and hip osteoarthritis started being distributed regularly to Group Health patients with these conditions who were considered candidates for joint replacement.

This is the first time anyone has explored how using decision aids in routine practice can affect health care and costs, Dr. Arterburn said. It is also the first major study of decision aids for knee and hip replacement.

“Our study’s real-world findings with the orthopedic decision aids are consistent with results of prior randomized trials of other kinds of decision aids,” Dr. Arterburn said. Those trials found that people were more likely to make informed choices that aligned with their preferences when they had access to objective, easily understood, evidenced-based information about the risks and benefits of treatment options. They also tended to choose more conservative, less invasive options-and to be more satisfied with whatever happened, regardless of whether they chose a surgical intervention.

The findings are important because more than 27 million Americans have osteoarthritis, which can cause severe pain and restrict functioning, including employment, Dr. Arterburn said. Joint replacement is among the most common U.S. orthopedic procedures, with more than 650,000 knees and 250,000 hips replaced each year, at a combined cost of $15.6 billion.

“Joint replacement can reduce pain and improve function for many patients,” said co-author Charles F. Jung, MD, Group Health’s chief of orthopedics. “But so can many nonsurgical actions that people can take to help ease their knee and hip arthritis.” Dr. Jung said. Because excess weight strains joints (particularly knees), the main action is to lose any extra weight. Other examples are physical therapy, nonsteroidal anti-inflammatory drugs like ibuprofen, avoiding injury, and mixing up a variety of low-impact activities, like walking, swimming, and biking. “These are the same things that we suggest for patients who choose surgery, to lower the risk of their new joint failing and needing to be replaced again, which can be more complicated,” he added.

“People often have wishful thinking about what joint replacement can do for them,” Dr. Jung said, “like our patient who thought he’d be his club’s singles-tennis champ again.” Biased information sources, including direct-to-consumer ads for artificial joints, may fuel such expectations. By contrast, decision aids serve as a balanced reality check, describing factors including the three-month recovery time, the 10- to 20-year lifespan of artificial joints, and risks such as infection and possible reoperation. “After people see a decision aid, they tend to come into our office with more realistic expectations, and we can have a more focused discussion about what matters most to them as individuals,” he added.

“We’re continuing to study the larger implementation strategy that a multidisciplinary team of Group Health leaders, providers, and staff developed for 12 decision aids in six specialties,” Dr. Arterburn said. Each of these decision aids is for patients at a crossroad: deciding whether to have an elective surgical procedure. As with joint replacement, deciding whether or not to choose any of those elective procedures tends to be a clinical “gray area,” with more than one treatment option, each with pros and cons-and little evidence to say any option is better than another.

“In 2009, as part of a large-scale quality-improvement program, we started introducing decision aids for all our patients facing decisions about these elective surgeries,” said co-author Matthew Handley, MD, Group Health’s associate medical director for quality and informatics. Group Health leaders were already convinced by the existing evidence that introducing decision aids would be good for patients. “So instead of just repeating another randomized trial, we started incorporating the decision aids into care for everyone,” he added.

“Group Health has distributed more decision aids than any other single health care organization in the world,” said co-author David K. McCulloch, MD, Group Health’s medical director for clinical improvement. By July 2012, more than 25,000 Group Health patients had received decision aids, adding around 900 more each month. Patients can watch the videos alone or with their families either on a DVD that is mailed to them or online on Group Health’s secure website for patients. “With all our specialty leaders, care providers, and staff seeing the decision aids,” he added, “our widespread implementation has improved our culture of care to make it even more centered on the individual patient.”

Tracking nationwide Medicare spending for more than two decades, Dartmouth Atlas of Health Care experts call care for clinical gray areas “preference-sensitive,” because it should reflect what individual patients need and prefer. But instead, they have found, this kind of care too often varies widely by geographical area, depending most on what local providers happen to want to do. Decision aids are meant to decrease these “unwarranted variations in care” by informing patients about the risks and benefits of treatment options. The aids may also help patients to clarify what they want and need, so their values and preferences carry more weight in the decision-making process.

In 2007, Washington became the first state to pass legislation recognizing the use of patient decision aids and “shared decision making” as a higher standard of informed consent. In shared decision making, health care providers inform patients about their options-often using decision aids-and help them to clarify what matters most to them and to make an informed decision.

Most of the September issue of Health Affairs focuses on payment reform: moving away from fee-for-service payment, where providers earn more for giving patients more tests and treatments, as in most of U.S. health care now. This concerns many people because, like getting less health care than needed, getting too much care-overdiagnosis and overtreatment-can harm patients. Payment reform is one solution that has been proposed for decreasing unwarranted variations in care. At Group Health, health care providers are paid a salary and receive no bonus for doing more procedures. So financial incentives at Group Health are aligned to keep patients healthy, instead of giving them more tests and treatments.

“But implementing decision aids and shared decision making can work well in fee-for-service settings too,” Dr. Arterburn said. “They just need health care providers who are concerned about having their patients make high-quality informed decisions – and most providers are.”

  • Additional
  • References
  • Citations

The Commonwealth Fund provided the main support for this study (grant #20080479). Three organizations funded Group Health’s implementation of decision aids: the Informed Medical Decisions Foundation (grant #0103); Group Health Foundation; and Health Dialog. The Informed Medical Decisions Foundation developed the video-based decision aids that this study used: “Treatment Choices for Knee Osteoarthritis” and “Treatment Choices for Hip Osteoarthritis.”

Drs. Arterburn, Handley, McCulloch, and Jung had four coauthors at Group Health Research Institute: Robert Wellman, MS, a biostatistician; Emily Westbrook, manager of the research project management office; Carolyn M. Rutter, PhD, a senior investigator; and Tyler Ross, MA, manager of research programming. Dr. Arterburn is also an affiliate associate professor of medicine and Dr. McCulloch is a clinical professor of medicine at the University of Washington School of Medicine; and Dr. Rutter is also an affiliate professor of biostatistics and health services at the University of Washington School of Public Health.

Group Health Research Institute

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Introducing Decision Aids May Lower Surgery For Arthritis’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Rheumatoid Arthritis Infection Risk Identified

Editor’s Choice
Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 05 Sep 2012 – 13:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:not yet rated

Healthcare Prof:not yet rated


Scientists have managed to predict when rheumatoid arthritis patients are most likely to suffer infections.
Not only is rheumatoid arthritis crippling and agonizing, it also makes the patient more vulnerable to infections that coincide with the disorder, increasing their risk of death. However, physicians have had a difficult time assessing the potential danger of infection an individual might face.

According to a Mayo Clinic study, a person’s chances of having severe infections can be predicted by developing a risk score, which uses information regarding the impact the disease has on a patient, plus factors including age, corticosteroid use and if any other illnesses are present.

The findings, which were published in the American College of Rheumatology journal Arthritis Rheumatism, came from medical records in the National Institutes of Health-funded Rochester Epidemiology Project of 584 individuals struggling with rheumatoid arthritis. The subjects were diagnosed between 1955 and 1994 and were observed until January 2000.

Almost half (252) of those studied needed hospitalization and/or intravenous antibiotic because of more than one severe infection. Collectively, the subjects had a total of 646 infections.

An infection risk score, based on those participants and other patients they observed, was created by the Mayo experts. In order to get an accurate calculation, scientists focused on certain factors, including:

  • previous severe infections
  • age
  • corticosteroid use
  • a low white blood cell count
  • elevated results in a blood test used to detect signs of inflammation, called an erythrocyte sedimentation rate
  • signs of rheumatoid arthritis outside the joints
  • the existence of other serious conditions such as heart disease, diabetes, lung disease, heart failure, alcoholism, and vascular disease.

The accuracy of the risk score was confirmed in a second group of people with rheumatoid arthritis from the same population.

Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic and leading author, explained:

“Using a risk score in this way can alert physicians that their patient is at high risk for infection and needs more frequent follow-ups, measures for infection prevention and possible changes in treatments. Rheumatoid arthritis patients are at higher risk of infection, and that risk is clearly not just because of the arthritis drugs.”

Further studies are required which focus on infection risk levels, so that patients may be prescribed the right drugs treat infections. The team added that infection risk impacts on what type of medications doctors may recommend, especially with regards to DMARDs (disease-modifying antirheuatic drugs). DMARDs are commonly used to treat rheumatoid arthritis.

In June 2012 German scientists tried to predict rheumatoid arthritis risk in an animal experiment with rabbits. They managed to successfully predict infection risk.

Written by Sarah Glynn

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

  • Additional
  • References
  • Citations

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Rheumatoid Arthritis Infection Risk Identified’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Researchers Study Use Of MRI In Osteoarthritis

Main Category: Arthritis / Rheumatology
Also Included In: MRI / PET / Ultrasound;  Bones / Orthopedics
Article Date: 03 Sep 2012 – 1:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:not yet rated

Healthcare Prof:not yet rated

A study conducted by researchers at Boston University School of Medicine (BUSM) shows that magnetic resonance imaging (MRI) detected a high prevalence of abnormalities associated with knee osteoarthritis in middle-aged and elderly patients that had no evidence of knee osteoarthritis in X-ray images.

Ali Guermazi, MD, PhD, professor of radiology at BUSM and chief of Musculoskeletal Imaging at Boston Medical Center (BMC), led this study in collaboration with researchers from Lund University in Sweden, Brigham and Women’s Hospital in Boston and Klinikum Augsburg in Germany. The findings are published online in BMJ.

Osteoarthritis, the most common form of arthritis, is characterized by a degeneration of cartilage and the underlying bone and other soft tissues in the joints, leading to pain and stiffness. According to the Centers for Disease Control and Prevention, osteoarthritis is the leading cause of disability in the United States, affecting approximately 26.9 million Americans. It is responsible for a significant portion of primary care visit and hospitalizations and has a large financial impact on health care. With the aging population, it is anticipated that the prevalence of osteoarthritis will continue to increase.

Prior studies have shown that only half of those with knee pain will have X-ray evidence of osteoarthritis. This study looked at how to further evaluate a patient’s knee pain if X-rays don’t show evidence of osteoarthritis. It also looked at whether MRI, in these cases, is of clinical value.

This observational study looked at the prevalence of MRI-detected abnormalities in a group of adults over the age of 50 who had no signs of knee osteoarthritis in X-ray images. The researchers looked at right knee MRIs of 710 ambulatory patients from the Framingham Osteoarthritis Study. Further analysis was performed on groups by age, gender, body mass index and the presence or absence of knee pain.

The results showed that approximately 90 percent of the knees that showed no signs of osteoarthritis using X-ray showed clear signs of osteoarthritis using MRI. In addition, MRI abnormalities were highly prevalent even in persons whose knees were not painful, suggesting that MRI was not a useful diagnostic test in this age group to evaluate knee pain.

“This data demonstrates a very high prevalence of MRI-detected osteoarthritis features in knees with no X-ray evidence of the disease,” said Guermazi. “While the MRI could be detecting early-stage osteoarthritis, further research is needed to determine what proportion of these individuals are diagnosed with knee osteoarthritis later in life.”

The researchers mention that MRI would be too expensive to perform as a routine imaging investigation.

  • Additional
  • References
  • Citations

Other BUSM researchers involved with this study include David Felson, MD, MPH, professor of medicine and epidemiology and principal investigator of the Framingham Osteoarthritis Study; Daichi Hayashi, MD, PhD, research assistant professor of radiology and Jingbo Niu, DSc, research assistant professor of medicine.

This research study was supported by grants from the National Institute of Aging under award number AG18393, the National Institute of Arthritis and Musculoskeletal and Skin Diseases under award number AR47785 and the Arthritis Foundation.

*Daniel Kirshenbaum, MD contributed to this press release.
Boston University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Researchers Study Use Of MRI In Osteoarthritis’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers

Main Category: Bones / Orthopedics
Also Included In: Genetics;  Arthritis / Rheumatology;  Pediatrics / Children’s Health
Article Date: 31 Aug 2012 – 1:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:5 stars

5 (2 votes)

Healthcare Prof:not yet rated

Researchers at Mount Sinai School of Medicine have identified the genetic cause of a rare and fatal bone disease by studying frozen skin cells that were taken from a child with the condition almost fifty years ago. Their study, which details how the MT1-MMP gene leads to the disease known as Winchester syndrome, appears in the online edition of The American Journal of Human Genetics.

In 1969, Patricia Winchester, MD, a pediatric radiologist in New York City, was asked to diagnose two young sisters who were losing bone in their hands and feet, developing severe arthritis in their fingers and losing movement of their shoulders, elbows, hips and knees because of osteoporosis. The frozen skin cells that were recently studied by principal investigator, John Martignetti, MD, PhD, and his team of researchers in the Department of Genetics and Genomic Sciences at Mount Sinai, had been taken from one of the sisters. Ultimately, the disease rendered the girls incapable of moving without assistance, and proved fatal.

The cause of the disease has remained unknown until now, when the study’s lead authors, post-doctoral students, Rebecca Mosig, PhD and Brad Evans, PhD, zeroed in on the MT1-MMP gene.

“This gene encodes an enzyme that needs to be specifically positioned on the membranes of cells to function correctly,” explains Dr. Martignetti. “What we discovered is that these girls had a gene mutation which resulted in incorrect shuttling of the protein. Instead of being directed to the cell surface where it could interact with the outside environment, the mutant protein never reached its final, correct destination and remained trapped in the cell’s cytoplasm. Mislocalized, it lost its ability to function and the children developed severe arthritis and bone The enzyme lost its ability to interact with another disease-casuing protein, MMP-2. Dr. Martignetti’s team had previously identifed mutations in the MMP-2 gene as the cause of a similar group of bone disorders in children.

The researchers says this recent discovery should provide diagnostic clarity and insight into possible treatments for children with Winchester syndrome, and other bone disorders, and for people in the general population who have osteoporosis and arthritis.

  • Additional
  • References
  • Citations

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Potential New Type Of Diagnostic Imaging Technology Using Collagen-Seeking Synthetic Protein Could Lead Doctors To Tumor Locations

Main Category: Medical Devices / Diagnostics
Also Included In: Arthritis / Rheumatology;  Cancer / Oncology
Article Date: 31 Aug 2012 – 2:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article


Advertisement

Patient / Public:not yet rated

Healthcare Prof:not yet rated

Johns Hopkins researchers have created a synthetic protein that, when activated by ultraviolet light, can guide doctors to places within the body where cancer, arthritis and other serious medical disorders can be detected.

The technique could lead to a new type of diagnostic imaging technology and may someday serve as a way to move medications to parts of the body where signs of disease have been found. In a study published in the Aug. 27-31 Online Early Edition of Proceedings of the National Academy of Sciences, the researchers reported success in using the synthetic protein in mouse models to locate prostate and pancreatic cancers, as well as to detect abnormal bone growth activity associated with Marfan syndrome.

Video of Michael Yu discussing a synthetic molecule called collagen mimetic peptide:

The synthetic protein developed by the Johns Hopkins team does not zero in directly on the diseased cells. Instead, it binds to nearby collagen that has been degraded by various health disorders. Collagen, the body’s most abundant protein, provides structure and creates a sturdy framework upon which cells build nerves, bone and skin. Some buildup and degradation of collagen is normal, but disease cells such as cancer can send out enzymes that break down collagen at an accelerated pace. It is this excessive damage, caused by disease, that the new synthetic protein can detect, the researchers said.

“These disease cells are like burglars who break into a house and do lots of damage but who are not there when the police arrive,” said S. Michael Yu, a faculty member in the Whiting School of Engineering’s Department of Materials Science and Engineering. “Instead of looking for the burglars, our synthetic protein is reacting to evidence left at the scene of the crime,” said Yu, who was principal investigator in the study.

A key collaborator was Martin Pomper, a School of Medicine professor of radiology and co-principal investigator of the Johns Hopkins Center of Cancer Nanotechnology Excellence. Pomper and Yu met as fellow affiliates of the Johns Hopkins Institute for NanoBioTechnology. “A major unmet medical need is for a better non-invasive characterization of disrupted collagen, which occurs in a wide variety of disorders,” Pomper said. “Michael has found what could be a very elegant and practical solution, which we are converting into a suite of imaging and potential agents for diagnosis and treatment.”

The synthetic proteins used in the study are called collagen mimetic peptides or CMPs. These tiny bits of protein are attracted to and physically bind to degraded strands of collagen, particularly those damaged by disease. Fluorescent tags are placed on each CMP so that it will show up when doctors scan tissue with fluorescent imaging equipment. The glowing areas indicate the location of damaged collagen that is likely to be associated with disease.

In developing the technique, the researchers faced a challenge because CMPs tend to bind with one another and form their own structures, similar to DNA, in a way that would cause them to ignore the disease-linked collagen targeted by the researchers.

To remedy this, the study’s lead author, Yang Li, synthesized CMPs that possess a chemical “cage” to keep the proteins from binding with one another. Just prior to entering the bloodstream to search for damaged collagen, a powerful ultraviolet light is used to “unlock” the cage and allow the CMPs to initiate their disease-tracking mission. Li is a doctoral student from the Department of Chemistry in the Krieger School of Arts and Sciences at Johns Hopkins. Yu, who holds a joint appointment in that department, is his doctoral adviser.

Yu’s team tested Li’s fluorescently tagged and caged peptides by injecting them into lab mice that possessed both prostate and pancreatic human cancer cells. Through a series of fluorescent images taken over four days, researchers tracked single strands of the synthetic protein spreading throughout the tumor sites via blood vessels and binding to collagen that had been damaged by cancer.

Similar in vivo tests showed that the CMP can target bones and cartilage that contain large amounts of degraded collagen. Therefore, the new protein could be used for diagnosis and treatment related to bone and cartilage damage.

Although the process is not well understood, the breakdown and rebuilding of collagen is thought to play a role in the excessive bone growth found in patients with Marfan syndrome. Yu’s team tested their CMPs on a mouse model for this disease and saw increased CMP binding in the ribs and spines of the Marfan mice, as compared to the control mice.

  • Additional
  • References
  • Citations

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Potential New Type Of Diagnostic Imaging Technology Using Collagen-Seeking Synthetic Protein Could Lead Doctors To Tumor Locations’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Collaborative Care Facilitates Therapy Compliance For Patients With Knee Osteoarthritis Improves Function, Pain, And Quality Of Life

Main Category: Arthritis / Rheumatology
Also Included In: Pharmacy / Pharmacist;  Rehabilitation / Physical Therapy
Article Date: 30 Aug 2012 – 0:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:not yet rated

Healthcare Prof:not yet rated

Canadian researchers have determined that community-based pharmacists could provide an added resource in identifying knee osteoarthritis (OA). The study, published in Arthritis Care Research, a journal of the American College of Rheumatology (ACR), represents the first evidence supporting a collaborative approach to managing knee OA. Findings suggest that involving pharmacists, physiotherapists, and primary care physicians in caring for OA patients improves the quality of care, along with patient function, pain, and quality of life.

OA is the most prevalent form of arthritis where a progressive loss of articular cartilage in the joints causes joint pain and could lead to functional disability. Nearly 27 million Americans over the age of 25 have some form of OA according to the Centers for Disease Control and Prevention (CDC). Joints that receive repetitive impact such as fingers, hips, and knees are most often affected by OA. Medical evidence estimates that knee OA occurs in 10% of men and 13% of women over the age of 59. Prior research projects a 50% increase in OA prevalence over the next 10 to 20 years, with aging and obesity reported as the leading contributors to this increase.

“Many cases of knee OA go undiagnosed and patients often do not receive timely care to relieve pain, improve function and prevent disability,” said lead author Dr. Carlo Marra, PharmD, PhD, a Director with the Collaboration for Outcomes Research and Evaluation (CORE) and Professor of Pharmaceutical Sciences at the University of British Columbia in Vancouver, Canada. “Our study investigates a multidisciplinary intervention that involves pharmacists in the identification and patient care for those with knee OA.”

For this randomized, controlled trial, the team engaged 14 pharmacies to provide intervention therapy and 18 pharmacies to offer usual care (control). At least two pharmacists at each location were asked to identify and enroll participants 50 years or older who experienced knee pain or stiffness on most days of the last month and fulfilled other criteria such as having a body mass index (BMI) greater than 25 kg/m2, not participating in a formal exercise program in the previous 6 months, and difficulty with activities due to knee pain. The 73 patients in the intervention arm received OA screening questionnaires, education, pain medication management, physical therapy exercises, and primary care physician (PCP) communication. There were 66 participants in the control group who were given an educational pamphlet.

Patients in the intervention arm had a significantly higher quality of OA care (as measured by a quality indicator pass rate) than those in the control group. At three months and six months, participants in the intervention arm saw significantly greater improvement in their overall pain and function scores compared to those receiving usual care. Dr. Marra concludes, “Our findings suggest that pharmacists can effectively initiate interventions that address the gaps in OA patient care. With the rise in OA, collaborative care presents a novel approach in prevent and treating those with knee OA.”

  • Additional
  • References
  • Citations

Full citation: “Pharmacist Initiated Intervention Trial in Osteoarthritis (PhIT-OA): A Multidisciplinary Intervention for Knee Osteoarthritis.” Carlo A. Marra, Jolanda Cibere, Maja Grubisic, Kelly A. Grindrod, Louise Gastonguay, Jamie M Thomas, Patrick Embley, Lindsey Colley, Ross T. Tsuyuki, Karim M. Khan, and John M. Esdaile. Arthritis Care and Research; Published Online: August 28, 2012 (DOI: 10.1002/acr.21763).
Wiley

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Collaborative Care Facilitates Therapy Compliance For Patients With Knee Osteoarthritis Improves Function, Pain, And Quality Of Life’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Osteoarthritis Pain Targeted

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics;  Seniors / Aging
Article Date: 23 Aug 2012 – 0:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:2 stars

2 (1 votes)

Healthcare Prof:not yet rated

The research relates to a family of molecules firstly discovered in Melbourne that applied to blood cell development. One of these, granulocyte macrophage colony-stimulating factor or GM-CSF, acts as a messenger between cells acting at a site of inflammation.

Professor John Hamilton has posed the question: could blocking GM-CSF action lead to a new treatment for inflammatory diseases? In experimental models of rheumatoid arthritis, Professor Hamilton and Dr Andrew Cook had previously shown that blocking GM-CSF function with an antibody suppressed the disease leading to clinical trials which are already showing patient benefit.

They have now shown, in a paper that has just appeared in the world’s top ranking arthritis journal, Annals of the Rheumatic Diseases, that GM-CSF depletion also suppresses pain in such models; they have also noted similar efficacy in an osteoarthritis experimental model.

“Without a doubt, quality of life and to be free from pain are important issues for people suffering with arthritis-related conditions” said Professor Hamilton.

Rheumatoid arthritis is a debilitating condition with the peak incidence being in people in their 30s and 40s. It is more common in women than in men.

“With our ageing population, the more common condition of osteoarthritis impacts more on our community and medical resources. A new therapy that can block such painful conditions would have massive benefits for health providers and governments in the future” said Dr Cook.

  • Additional
  • References
  • Citations

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Osteoarthritis Pain Targeted’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Oral Drug Shows Clinical Response And Remission In Some Patients With Ulcerative Colitis

Main Category: Arthritis / Rheumatology
Also Included In: Crohn’s / IBD
Article Date: 16 Aug 2012 – 2:00 PDT

email icon email to a friend   printer icon printer friendly   write icon opinions  

<!– rate icon rate article



Patient / Public:not yet rated

Healthcare Prof:not yet rated

An investigational drug currently under FDA review for the treatment of rheumatoid arthritis has now shown positive results in patients with moderate-to-severe ulcerative colitis, according to researchers at the University of California San Diego, School of Medicine. The study will appear in the August 16, 2012 issue of the New England Journal of Medicine (NEJM).

Results from the phase 2 clinical trial showed the drug Tofacitinib achieved clinical response and remission in certain patients suffering from ulcerative colitis – a chronic inflammatory disease of the colon where patients experience painful episodes of rectal bleeding and diarrhea combined with the urgent need to use the restroom.

“Ulcerative colitis causes severe bouts of illness that adversely affect a patient’s quality of life at home and work.” said William Sandborn, MD, chief of the Division of Gastroenterology at the UC San Diego School of Medicine and director of the Inflammatory Bowel Disease Center at UC San Diego Health System. “Oral treatment with Tofacitinib resulted in improvement and remission in some patients.”

Currently, there are limited types of drugs to treat ulcerative colitis. Drugs available are not universally effective and some require intravenous administration.

“This is a whole new class of drug that affects the number of proteins in the immune system that cause this type of inflammatory bowel disease (IBD),” said Sandborn.

There are about 600,000 to 700,000 patients suffering from ulcerative colitis in the United States. Half of these patients experience severe flare ups that in some cases could progress to surgery where the colon is completely removed.

“Patients with a more advanced case of ulcerative colitis need a potent and highly effective therapy,” said Sandborn. “The results of our study show Tofacitinib may provide a new approach to attacking this disease.”

One hundred and ninety four patients were part of the randomized trial, which was conducted at 51 centers in 17 countries. Eligible patients were at least 18 years of age, had a confirmed diagnosis of ulcerative colitis and had previously been treated with conventional therapy for the disease.

The patients were treated for eight weeks. They were given a dose of Tofacitinib twice daily, and benefits could be seen as early as two weeks. A flexile sigmoidoscopy was performed at the beginning and end of the trial, along with blood work and stool samples as a measurement of intestinal inflammation.

Among patients treated, the most commonly reported infections were influenza and nasopharyngitis – a respiratory infection with common-cold symptoms. Two patients developed an abscess, and in some cases, headaches were reported and the ulcerative colitis worsened.

“The goal of this study was to show that the oral inhibitor is effective in treating ulcerative colitis. The next phase of studies aim to confirm the efficacy and safety profile of the drug, will examine the long term or maintenance effect of Tofacitinib and confirm the results of this study,” said Sandborn.

  • Additional
  • References
  • Citations

Researchers who also participated in this study include Subrata Ghosh, MD, University of Calgary; Julian Panes, MD, Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain; Ivana Vranic, PhD, Chinyu Su, MD, Samantha Rousell, MSc, and Wojciech Niezychowski, MD, all at Pfizer Inc.

The study was funded by Pfizer Inc.
University of California – San Diego

Please use one of the following formats to cite this article in your essay, paper or report:

MLA


APA


Please note: If no author information is provided, the source is cited instead.


Add Your Opinion On This Article

‘Oral Drug Shows Clinical Response And Remission In Some Patients With Ulcerative Colitis’

Please note that we publish your name, but we do not publish your email address. It is only used to let
you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care
professional. For more information, please read our terms and conditions.

MediLexicon International Ltd Logo

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.

Everyday Health Network

back to top | home |
privacy policy

MediLexicon International Ltd Logo

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.
MNT (logo) is the registered EU trade mark of MediLexicon Int. Limited.